Headaches and digestion
Headaches & dizziness
For tension headaches, migraines and lightheadedness
with a medical interpreter
24 hours a day, 365 days a year
OK to consult together
payment information
About
About Headaches & dizziness
We treat tension headaches, migraines, dizziness and unsteadiness. You can also consult us about medication for recurring headaches.
Why it happens
Most headaches are caused by tension in the muscles of the head, neck and shoulders (tension headaches) or by oversensitive reactions of blood vessels and nerves in the brain (migraines), and most are not life-threatening. However, some headaches are caused by conditions such as diseases of the blood vessels in the brain or infections, so it's important to tell them apart by how the pain starts and what symptoms come with it. Dizziness has many causes, including problems with the balance organ deep in the ear (the inner ear), changes in blood pressure, dehydration, anemia, autonomic imbalance and brain conditions.
What's happening in the body
Broadly speaking, headaches arise in two ways. The first type has no underlying problem in the brain or blood vessels themselves. In migraines, the nerves in the brain become oversensitive, and their signals are thought to cause inflammation around blood vessels, producing a throbbing pain. That's why people become sensitive to light and sound or feel nauseous. In tension headaches, the muscles covering the neck, shoulders and head stay tense, causing a squeezing pain. The second type has a cause in or around the brain. Bleeding, inflammation or swelling irritates the membranes and blood vessels surrounding the brain and causes pain. This type may need emergency care. We assess which is more likely based on the nature of the headache, how it started and the symptoms that come with it.
Main symptoms
- Throbbing, pulsing pain (can occur with migraines)
- A tight, squeezing pain around the whole head (can occur with tension headaches)
- Sensitivity to light, sound or smells
- Headache with nausea
- With stiff shoulders or neck
- Spinning dizziness (vertigo)
- Lightheadedness when standing up, or a floating feeling
- Dizziness with ringing in the ears or a blocked feeling in the ear
When you can wait and see
What you can do yourself
- Keep a record of when headaches occur, the situation and possible triggers (a headache diary)
- For migraines, resting in a dark, quiet room and cooling the painful area may help
- For tension headaches, warm your neck and shoulders and review your posture and workspace
- Drink fluids often (dehydration can trigger headaches and dizziness)
- Keep regular sleeping hours and avoid sleeping too much or too little
Please consult us
If any of the following apply
- You get headaches repeatedly
- You feel dizzy or unsteady
- Over-the-counter medication isn't helping
Seek care right away
If any of the following apply
- A sudden, severe headache unlike any before (peaking within a few seconds to 1 minute)
- Numbness or weakness in the arms or legs, slurred speech, or one side of the face drooping
- Severe headache with high fever, stiff neck or vomiting
- Drowsiness or confusion, or has had a seizure
- Headache after hitting the head, double vision, or part of the field of vision missing
Don't wait for a Cotovia consultation; call the emergency number in your country.
See the emergency guide for each countryIf you're not sure, ask us on LINE
Differential
Telling it apart from similar conditions
Symptoms that look the same may need different care depending on the cause. Use this as a guide to find what's closest to your situation.
Migraine
Throbbing pain, sensitivity to light and sound, nausea, worse with movement
You can discuss medication for attacks and options for prevention
Tension headache
A squeezing feeling around the whole head, with stiff shoulders and neck, not worse with movement
We consider adjusting posture and rest, and treatment as needed
Dehydration
After activity in the heat, with a dry mouth and passing less urine
Replacing fluids and electrolytes may relieve it
Medication overuse headache
Using painkillers on 10 or more days a month, with headaches becoming more frequent
Your medication use needs to be reviewed
Subarachnoid hemorrhage and similar conditions
A sudden, severe headache unlike any you've had before
Consider emergency services immediately
Meningitis
A headache with fever and a stiff neck that's hard to bend forward
Seek care urgently
* This is not a complete list. If you're not sure, please consult us.
When it might be something else
Course
Typical course
This is the general course. Actual progress varies from person to person.
- Migraine warning signs
You may see flickering lights, start yawning or notice other changes
Acting at this stage may be effective
- Start of the attack to a few hours
The pain gets stronger, and light and sound become hard to bear
Resting in a dark, quiet place helps
- 4–72 hours
Migraine attacks often last within this range
Please consult us if it lasts more than 72 hours or feels different from usual
- After the attack
You may feel drained for a while
Take it easy, and get enough sleep and fluids
Local Insight
For people living in Southeast Asia
The climate, healthcare and access to medication differ from Japan. Here are points specific to this region.
Moving back and forth between hot, humid outdoors and air-conditioned indoors can cause dehydration and strain the autonomic nervous system, triggering headaches and dizziness. On days with a lot of outdoor activity, it helps to consciously replace fluids and salt.
Dengue is known for severe headache and pain behind the eyes. With a headache and fever, the possibility of a mosquito-borne infection should be kept in mind.
Changes in environment right after a posting, jet lag, and stress from language and work can trigger tension headaches and migraines. Mental health issues may also be involved.
The migraine medication you used in Japan may not be available locally as the same product. If you want to continue it, please consult us early.
Care
What Cotovia can do
- Assessing your symptoms through a consultation
- Prescriptions for painkillers, migraine medication and dizziness medication (prescribing is at the doctor's discretion)
- Guidance on where to go if you have a sudden severe headache or neurological symptoms
Tests you may have
Not knowing what will happen can make people hesitate to seek care, so here's what actually takes place.
Medical history
Narrowing down the cause from the nature of the pain, how it started and accompanying symptoms
Neurological examination
Checking strength and sensation in the arms and legs, eye movements and more
Blood pressure and blood tests
Assessing high blood pressure, anemia, dehydration and inflammation
Head imaging
Ruling out urgent causes such as bleeding or swelling
Treatment options
Painkillers for attacks
Ease the pain
Using them too often can actually increase headaches. Please tell us how many days you use them
Medication for migraine attacks
Stops migraine attacks
Timing matters for it to work well. Prescribing is at the doctor's discretion
Preventive treatment
Reduces the number of attacks
An option when attacks are frequent
Lifestyle adjustments
Reduce triggers
Together we review sleep, fluids, posture, exposure to air conditioning and more
* Tests, procedures and prescriptions are decided by the doctor after a consultation. Services may vary by country and location.
Preparation
Before your visit
When seeing a doctor abroad, simply organizing what you need to say makes a big difference.
What to bring
- Passport or residence card
- Insurance card and your insurer's contact details
- Your medication record and the medication you take
- Your headache record, if you have one (when, how bad, what you took)
What to tell us
- Where the pain is and what it's like (throbbing or squeezing)
- How it started (suddenly or gradually)
- Accompanying symptoms (nausea, sensitivity to light or sound, paralysis, fever)
- How many days a month you take painkillers
- Whether it's the worst headache you've ever had
Self Care
What you can do yourself
Along with seeing a doctor, here are things to keep in mind in daily life.
Prevention
- Regular sleep and meals
- Take breaks during long periods on a computer or smartphone
- Prevent dehydration (make a conscious effort to replace fluids and electrolytes in hot conditions)
- Identify and avoid triggers such as certain foods, alcohol, bright light and noise
How to Consult
How to be seen
Choose from 3 ways to be seen, depending on your symptoms and schedule. If you're not sure, we'll guide you on LINE.
Online consultations
See a doctor by video call from home or the office. Medication delivered or from a pharmacy.
Available for this symptom
In-person care
In-person consultations at our clinics and partner hospitals, including tests and procedures.
Available for this symptom
Cotovia Counter
Support with an interpreter for visits to general hospitals.
Available for this symptom
If an online consultation finds that tests or procedures are needed, we'll guide you to in-person care or Cotovia Counter.
From consultation to receiving medication
Add us on LINE and consult
Tell us your symptoms, and we'll recommend the right way to be seen.
Book and be seen
See a doctor online or at the nearest location, with an interpreter present.
Receive your medication
Have it delivered or pick it up at a pharmacy or the clinic (varies by country).
Follow-up
You can also consult us on LINE about how you're doing afterward.
Special Care
People who need extra care
Children
Children may not be able to describe a headache, and it may show up as irritability or loss of appetite
Pregnant women
Some medications can't be used. Headaches and swelling in late pregnancy may also need attention
People with high blood pressure
A sudden rise in blood pressure can cause headaches
People whose headaches began after the age of 50
New headaches should have their cause assessed
FAQ
FAQ
Common questions before a visit, and common assumptions that lead people to judge for themselves.
QWhat kinds of headaches need urgent care?
A sudden severe headache, neurological symptoms such as numbness in the arms or legs or slurred speech, and a headache with high fever and a stiff neck are considered urgent. In these cases, please consider local emergency services.
QI often take over-the-counter painkillers. Is that a problem?
Using painkillers on 10 or more days a month is known to make headaches more likely. If you use them often, please consult us.
QIs dizziness caused by the ears or the brain?
Sometimes it can be inferred from how symptoms start and what comes with them, but an examination is needed to confirm. Difficulty walking or paralysis in the arms or legs suggests an emergency.
QCan I consult online?
Yes. However, if warning signs are suspected, or the doctor decides a detailed neurological examination or imaging is needed, we'll guide you to in-person care.
Common misconceptions
Myth Headaches are something you just have to put up with
Fact There are treatment options. Recurring headaches in particular are worth recording and discussing with a doctor
Myth The more painkillers you take, the better they work
Fact Using them on 10 or more days a month can lead to headaches caused by the medication itself
Myth A brain scan will always find the cause of a headache
Fact Migraines and tension headaches don't show up on imaging. Diagnosis is based mainly on your history
Myth A headache from the heat goes away if you drink water
Fact You also need to replace the salt lost through sweat. Water alone may not be enough
Myth Even a sudden severe headache can be watched and waited out
Fact A severe headache unlike any you've had before is a sign that needs emergency care
Feel free to ask us on LINE first
It's fine to contact us even if you're not sure you need to see a doctor. We're available in Japanese 24 hours a day, 365 days a year.
- Symptoms
- When it started
- Your country of residence
- How you'd like to be seen
Sending these 4 things helps us respond faster. It's fine if you don't have them all.
Ask us on LINE